Prior to the introduction of combination antiretroviral therapy (ART) in 1996, persons with HIV (PWH) had very high rates of mortality, mostly due to AIDS. Since then, life expectancies have increased dramatically as PWH have been able to successfully suppress the virus due to ART, reducing the risk of AIDS and death. Increasing life expectancies among PWH have meant that PWH are ageing with reduced mortality due to AIDS and increased mortality due to other causes that are common in the general population (e.g. cardiovascular disease, cancer). Additionally, substance use and comorbidities such as hepatitis C tend to be more common among PWH than in the general population, leading to increased mortality rates due to these causes. Between 2012 and 2015, international treatment guidelines evolved to recommend that all PWH should receive ART regardless of their disease stage, which was previously not the case. This has led to further reductions in AIDS incidence and mortality and at the same time more effective ART regimens with fewer side effects have come available. This is leading to changing demographic profiles of populations of PWH, which will bring further changes in causes of death - policy makers will need to plan accordingly.
Aims and objectives
Work theme 1 (WT1): To describe the changing historical patterns of causes of mortality among PWH up to the present day in a variety of settings (consisting of both high-income and low-and-middle income countries [LMICs]), including analysing the impact of the COVID-19 pandemic.
Work theme 2 (WT2): To project future patterns of causes of mortality among PWH in both high-income and LMICs.
WT1 will start with a literature review summarising existing evidence on changes in causes of mortality among PWH. Using North American and Western European data from the Antiretroviral Therapy Cohort Collaboration (ART-CC), managed by the University of Bristol, and online data from the Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA) network, the student would investigate and compare longitudinal patterns of causes of death among PWH between the two datasets using epidemiological techniques (e.g., survival analysis, regression). The student would participate in the process of assigning causes of death for the ART-CC’s 2022 data update and would look to improve the current processes. Subsequently, the student would use epidemiological techniques on the 2022 dataset to investigate how the COVID-19 pandemic has affected cause of death patterns. WT2 would involve developing an infectious disease transmission model to predict future demographic trends among PWH (e.g., age, ART status) for various settings and analyse how this will affect mortality and patterns of causes of death. The PhD would provide cutting-edge training in evidence synthesis and statistical modelling and would give the opportunity to present findings at international infectious disease conferences, and to use the supervisory group’s links to liaise with HIV policy makers.
How to apply for this project
This project will be based in Bristol Medical School - Population Health Sciences in the Faculty of Health Sciences at the University of Bristol.
Please visit the Faculty of Health Sciences website for details of how to apply